Impact of COVID-19 Lockdown Policy on Homicide, Suicide ......2020/07/11 · The mental health effects of COVID-19 and of the accompanying economic crisis have also been profound,

1

Impact of COVID-19 Lockdown Policy on Homicide, Suicide, and Motor

Vehicle Deaths in Peru

Renzo JC Calderon-Anyosa, MD1, Jay S Kaufman, PhD1

1 Department of Epidemiology, Biostatistics and Occupational Health,

McGill University, Montreal, Canada

Corresponding author information:

Renzo JC Calderon-Anyosa, MD MSc

Department of Epidemiology, Biostatistics and Occupational Health, McGill University

1020 Pine Ave W, Montreal, Quebec H3A 1A2

[email protected]

Word count: 2816 | Number of pages: 11 | Tables: 1 | Figures: 3

Conflict of interest statement:

Renzo Calderon-Anyosa: No Conflict of Interest

Jay S Kaufman: No Conflict of Interest

Financial disclosure: RCA was supported by a Tomlinson Doctoral Fellowship. No other

funding was received.

. CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted July 14, 2020. ; https://doi.org/10.1101/2020.07.11.20150193doi: medRxiv preprint

NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

https://doi.org/10.1101/2020.07.11.20150193

http://creativecommons.org/licenses/by-nc-nd/4.0/

2

Abstract

Introduction: Although lockdown measures to stop COVID-19 have direct effects on disease

transmission, their impact on violent and accidental deaths remains unknown. Our study aims to

assess the early impact of COVID-19 lockdown on violent and accidental deaths in Peru.

Methods: Based on data from the Peruvian National Death Information System, an interrupted

time series analysis was performed to assess the immediate impact and change in the trend of

COVID-19 lockdown on external causes of death including homicide, suicide, and traffic

accidents. The analysis was stratified by sex and the time unit was every 15 days.

Results: All forms of deaths examined presented a sudden drop after the lockdown. The biggest

drop was in deaths related to traffic accidents, with a reduction of 12.66 deaths per million men

per month (95% CI: -15.56, -9.76) and 3.64 deaths per million women per month (95% CI:-5.25,

-2.03). Homicide and suicide presented similar level drop in women, while the homicide

reduction was twice the size of the suicide reduction in men. The slope in suicide in men during

the lock-down period increased by 3.62 deaths per million men per year (95% CI:0.06, 7.18). No

other change in slope was detected.

Conclusions: Violent and accidental deaths presented a sudden drop after the lockdown was

implemented and an increase in suicide in men was observed. Falls in mobility have a natural

impact on traffic accidents, however, the patterns for suicide and homicide are less intuitive and

reveal important characteristics of these events, although we expect all of these changes to be

transient.



https://doi.org/10.1101/2020.07.11.20150193


3

Introduction 1

2

COVID-19 has had a serious impact on population health worldwide 1, not only as a direct 3

consequence of the infection but also due to the measures taken to reduce its transmission. These 4

unprecedented changes in the lifestyles of millions have also impacted mental health, society and 5

economy in various ways 2,3. 6

7

The main strategies to reduce COVID-19 transmission are social distancing and isolation 8

measures. Policies range from advising individuals to keep apart a physical distance (i.e. 2 9

meters) in public spaces all the way to generalized lockdowns 4, all to reduce the pace of 10

transmission and to prevent health services from being overwhelmed 5. 11

12

By the middle of June 2020, Latin-America had become a focus of COVID-19 infection. To slow 13

the spread, most of the countries in the region have taken severe lockdown measures 6. Peru was 14

one of the countries with the earliest and strictest national lockdown measures in Latin-America 15

and has won international recognition for its pandemic response, starting restrictions right after 16

the first confirmed case in mid-March 2020 and lasting for over 100 days until the end of June in 17

most of the national territory 6–9. 18

19

Although measures such as national lockdowns are expected to have a direct impact on 20

transmission and subsequent mortality due to COVID-19 infection10–12, their interruption of all 21

daily activities suggest that they may also impact other aspects of health and causes of death 13–15. 22

Radical changes in the daily activities of individuals, self-isolation, financial uncertainty, job 23



https://doi.org/10.1101/2020.07.11.20150193


4

losses, and reduced incomes have the potential to influence mortality due to violent crimes, 24

suicides, domestic violence, and other external causes of death 16–19. 25

26

Early reports have indicated a substantial drop in violent crime rates across the world, with an 27

overall drop in crime close 50% in some cities following some of the most restrictive measures 28

20,21. At the same time, reports of domestic violence have increased since social distancing 29

measures came into effect, as victims are forced to be isolated with their abusers22,23. The UN has 30

estimated that domestic violence has increased by over 30% in some countries since lockdown 31

with a surge in the need for shelters24,25. 32

33

Lockdowns have also been accompanied by travel bans and a reduction in mobility, leading to a 34

decrease in the use of motor vehicles use26 with a consequential drop in traffic accidents and 35

resultant emergency visits and deaths27,28. The mental health effects of COVID-19 and of the 36

accompanying economic crisis have also been profound, with suicide as a concern16. Previous 37

pandemic scenarios have also shown a change in suicide trends including the 1918 influenza 38

pandemic and 2003 SARS epidemic29,30. 39

40

Although by the end June 2020 most countries have relaxed their lockdown measures, their 41

diverse consequences are still unclear and are just now beginning to be studied empirically. Our 42

study aims to assess the early impact of the COVID-19 national lockdown on homicide, suicide, 43

and traffic accident deaths in the Peruvian setting. 44

45

Methods 46

47



https://doi.org/10.1101/2020.07.11.20150193


5

Study population 48

49

We used data from the Peruvian National Death Information System (SINADEF)31 which 50

collects daily death certificates nationwide with available data since 2017. SINADEF has 51

improved the quality of data registration in the recent years, managing to improve its coverage 52

and represents close to 80% of all deaths in the national territory32. For this study, we have 53

included nationwide information on deceased adults (18 years old or older) from January 1st, 54

2017 to June 28th, 2020. 55

56

On March 16, 2020, the Peruvian government decreed a state of sanitary emergency, suspending 57

economic, academic, and recreational activities across the entire country of 32 million people. 58

Only essential activities including food supply, pharmacies, and banking remained active. 59

Moreover, international borders were closed, military and police patrolled the streets, and a 60

curfew was instituted from 8 p.m. to 5 a.m. Public transport capacity was also reduced by half 61

and movement between regions within the country was banned. Although some of the 62

components of the lockdown have changed throughout its implementation, the core aspects of the 63

lockdown remained constant until the end of June 2020 7,8. 64

65

Measures 66

67

Because the lockdown was implemented in the middle of March and there is a relatively low 68

count of daily deaths, we chose to aggregate the data in bins of 15 days each to have a uniform 69

time unit throughout our study period. 70

71



https://doi.org/10.1101/2020.07.11.20150193


6

Violent and accidental death information, sex, and age were taken directly from the SINADEF 72

report. This report has an independent item for violent forms of deaths including homicide, 73

suicide, traffic accidents, and other types of accidental deaths. This information is recorded by the 74

health worker that certifies the death. The number of events was transformed into the rate per 75

1,000,000 population for better comparison based on the population report from the latest 76

National Census33. 77

78

Because the COVID-19 pandemic imposes additional stress on health workers and the health 79

system, the reporting, recording, and coding of deaths could be affected by this overload of 80

work34,35. To estimate if violent deaths recording was affected by this scenario, we also estimated 81

the proportion of violent deaths labeled as “unspecified” as a proportion of the total violent 82

deaths. This fraction was assessed in the same way as the main outcomes to find any change in 83

the trends after lockdown. 84

85

To have a measure of the degree of compliance with lockdown and an approximation to the use 86

of motor vehicles we used descriptive data from the mobile-phone mobility data provided by 87

Google Community Mobility Reports for public transit places36. This report presents the percent 88

change in visits to transport places for each day compared to a baseline value for that day of the 89

week. 90

91

Statistical analysis 92

93

To assess the immediate impact and change in the trend of COVID-19 lockdown, we analyzed 94

the violent death rates per population using an interrupted time series analysis37. A linear 95



https://doi.org/10.1101/2020.07.11.20150193


7

regression model was fitted to the violent deaths rates with a time variable (every 15 days), a 96

variable to indicate post-lockdown, which was defined since March 16, 2020, and an interaction 97

term between the post-lockdown indicator and the time variable, to evaluate a change in the slope 98

of the outcome trend after lockdown. Stratified analysis was performed for women and men 99

because of known differences in violent deaths by sex. Autocorrelation of the time series was 100

assessed through a correlogram and seasonality through visual inspection of the plots. The 101

analysis was conducted using R 3.6.1. 102

103

Results 104

105

A total of 388,772 events were identified as adult deaths from January 1st, 2017 to June 28th, 106

2020. Violent and accidental deaths sum up to 14,526 including 6,700 traffic accidents, 2,849 107

homicides, 1,611 suicides, and 3,366 other forms of accidental deaths. No autocorrelation or 108

seasonality was found in any time series because the entire follow-up period spanned only 3.5 109

months. 110

111

The time slope in the pre-lockdown period was positive for all types of violent deaths in both sex 112

groups with the highest for male traffic accidents, with an extra 0.75 deaths per year per million 113

men (95%CI: 0.51, 0.99) and the lowest in female homicides, with an extra 0.10 deaths per year 114

per million women (95%CI: 0.04, 0.16). All forms of violent and accidental deaths presented a 115

sudden drop after the implementation of the lockdown in both groups. The biggest difference in 116

the post-lockdown period was in deaths related to traffic accidents, with a reduction of 12.66 117

deaths per million men per month (95% CI: -15.56, -9.76) and a reduction of 3.64 deaths per 118

million women per month (95% CI:-5.25, -2.03) after the lockdown. Homicide and suicide 119



https://doi.org/10.1101/2020.07.11.20150193


8

presented a similar level drop in women with around 1 fewer death per million women per 120

month, while the homicide reduction was twice the suicide reduction in men with 6 and 3 drops 121

in deaths per million men per month respectively. Other forms of accidental deaths in women 122

presented a reduction of 2 deaths per million women per month, being the second-highest drop in 123

this group (Table 1). We detected an increase in the slope of suicides in men in the post-124

lockdown period with an extra 3.62 deaths per million men per year (95%CI: 0.06, 7.18) from the 125

pre-lockdown period slope. No other change in the post-lockdown slope compared to the pre-126

lockdown period was found in the other types of violent or accidental death in women (Figure 1) 127

or men (Figure 2). The post-lockdown follow-up is short and so there is low power to detect a 128

slope change among these points38. 129

130

There was no change in the level or the trend of the unspecified violent death proportion (Figure 131

3A). The mobility data (Figure 3B) shows an early drop in mobility to transit stations right after 132

the first confirmed case with a gradual reduction until the start of the lockdown. After lockdown, 133

the mobility fell below -75% after the second day and held constant at around -80% for 40 days. 134

After that period, mobility gradually recovered, with an increasing tendency through the end of 135

the lockdown. The episodic drops shown close to -100% represent the strict curfew on Sundays 136

and holidays. 137

138

Discussion 139

140

In this nationwide time series analysis, we found that lockdown implementation was associated 141

with a sudden reduction in all major forms of violent and accidental deaths (homicides, suicides 142

and traffic accidents represented 79% of total violent and accidental deaths in 201939) with a 143



https://doi.org/10.1101/2020.07.11.20150193


9

detected change in the post-lockdown trend of suicides in men. Nonetheless, we do expect rates 144

to return to their pre-pandemic levels at some future point. The biggest immediate absolute 145

reduction was seen in traffic accidents and the smallest in suicides, but of course this also reflects 146

the higher absolute burden of traffic accidents as a cause of death. 147

148

These results are consistent with both the theoretical rationale behind lockdown and various early 149

reports in other parts of the world. The change in lifestyle and behaviors associated with limited 150

outside activities and economic shutdown must certainly play a role in the mechanism behind the 151

acute change in the rates of these types of deaths. Falls in mobility have a natural impact on road 152

traffic accidents, since people staying at home are at no risk for these events. The decreases in 153

suicide and homicide are less obvious. Suicide might be expected to increase from economic and 154

social stress and the disruption of daily routine40,41. 155

156

Expectations about homicide are also not so clear. As lockdown measures began, conventional 157

crimes began to slow down around the world. Studies that evaluated the short-term effects of 158

lockdown on different types of crime reports in Los Angeles and Indianapolis in the USA found a 159

marked decrease in the robbery, burglary, and aggravated assault after the stay-at-home measures 160

took place18,42. 161

162

Most homicides in men in Latin-America and around the world are associated with crime43,44, and 163

since lockdown, both murder and crime decreased in the region45. In Mexico, murder rates, which 164

started at a historic high in 2020, dropped dramatically almost halfway from the national average 165

of 81 per day to 54 after social distancing measures were put in place46 and a similar pattern has 166

been seen in other countries in the region. Although there is an initial drop and sustained low 167



https://doi.org/10.1101/2020.07.11.20150193


10

crime rate while in lockdown, a greater change is expected once lifted due to economic 168

uncertainty. In our time series analysis, we also found a marked dropped in homicides after 169

lockdown. Although this aligns with most reports in the region, this decrease in homicides 170

contrasts with what is happening in some cities in the USA where crime is down, but murder is 171

up, without a clear explanation of this divergence 47. Now in the post-lockdown period of our 172

time series there is already the first hint of a subtle increase in the rates of homicides. 173

174

Most homicides in men are associated with crime, however, most homicides in women are hate 175

crimes or feminicides. In Peru, the first cause of homicide in women is intimate partner violence, 176

with 1 of every 5 women having the partner as the perpetrator 48. Lockdown and isolation 177

measures to prevent the spread of COVID-19 have created greater risks for women living in 178

situations of domestic violence23,24,49. Although we found a reduction in women’s homicides 179

overall, this does not exclude the increase in other forms of intimate partner violence, rather, it 180

reflects the conditions in which femicides occur. According to a study carried out in autopsies of 181

women victims of violence, the most frequent place where the body was found was in public 182

places, rivers, or open fields (43.4%), compared to the home (22.9%)50. Lockdown restrictions 183

may have imposed an additional barrier in the occurrence of these tragic acts as police and 184

military were constantly watching the streets. 185

186

Mental health during lockdown has also been a constant concern13,15,16,51,52. Some initial reports 187

show the increase in suicides rate during this pandemic as a consequence of lockdown, financial 188

stress, uncertainty, and isolation52,53. Two possible projection scenarios based on an increase in 189

unemployment in Canada following the COVID-19 pandemic resulted in a projected total of 11.6 190

to 13.6 excess suicides in 2020-2021 per 100 00054. Our results show that after lockdown the 191



https://doi.org/10.1101/2020.07.11.20150193


11

immediate rate of suicides declined, however, men presented a detectable increase in the slope of 192

suicides in the post-lockdown period. One of the factors may be the shutdown of the economic 193

activities and the financial stress during the post-lockdown period. Nearly 81% of men in Peru 194

have a paid job compare to 64% women55, and during the pandemic, the male working population 195

in the country capital decreased by 47.3% and the female working population by 48.1%56. These 196

initial changes in suicide trends may give us an idea of what might come next as a result of these 197

social changes. 198

199

Traffic accidents were the type of violent death that decreased the most and this observation is 200

consistent with many of the specific restrictions adopted, including the general limit of transit as 201

well as the imposition of strict curfews at night and on Sundays. Other countries have also seen a 202

decline in emergency room visits for trauma injuries related to traffic accidents after the 203

lockdown28,57. 204

205

An increasing rate towards the end of the lockdown is more apparent for traffic accidents than for 206

other types of death. This mirrors quite closely the changes observed in mobility trends. Both, 207

traffic accident deaths and the mobility change present as U-shaped trends during lockdown, 208

demonstrating that the lockdown measures were not fully adopted at the beginning and that they 209

eased gradually towards the end. Other forms of violent death have also shown a decline and 210

even appear to be in decline after the lockdown, however, as economic activities resume, this rate 211

may recover the baseline level as with the other types of death. 212

213

This report constitutes an initial analysis of the trends in violent deaths and as such, we recognize 214

some limitations. Although we found that there was no major change in the occurrence of deaths 215



https://doi.org/10.1101/2020.07.11.20150193


12

coded as “unknown” cause, after lockdown, underreporting may be possible for other coding 216

variables. This is a nationwide analysis and some differences by region may not be captured. Peru 217

has tremendous diversity of lifestyle between coastal, mountain and jungle regions, and data 218

come from large cities and small rural communities with radically different rates of events. 219

Competing risk due to COVID-19 is also a possibility although most of the violent deaths occur 220

in the younger population, and not necessarily in the population at risk of dying because of 221

COVID-19. For suicide, however, the populations may overlap to a greater extent58. Our analysis 222

only considers the beginning and end of the lockdown thus the sudden initial drop that we have 223

described may be accompanied by a sudden increase after the measures are lifted and a later 224

follow-up analysis would be informative. 225

226

There is an urgency to consider and understand the myriad indirect mortality consequences of the 227

policies adopted to respond to COVID-19. It is expected that some time after the lockdowns are 228

completely lifted around the world, the lives lost from the impacts of these various policies on the 229

economy, lifestyle, and mental health will outweigh the number of lives lost directly from 230

infection. Indicators of this broad impact, including the types of violent and accidental deaths 231

studied here, will be crucial for future decision-making59. 232

233

Conclusions 234

235

Lockdown due to COVID-19 has impacted the rates of violent and accidental deaths, showing a 236

sudden drop after its implementation and an increase in the slope of suicide in men in the post-237

lockdown period. The biggest change was seen in deaths as a consequence of traffic accidents. 238



https://doi.org/10.1101/2020.07.11.20150193


13

This initial drop should not be considered as encouraging, since just as there was a marked drop 239

at the beginning, it is likely to be an equally sharp increase after the lockdown is lifted and the 240

economic activities are resumed. The patterns for suicide and homicide are less intuitive, 241

however, and reveal important clues about the causes and characteristics of these events. Policies 242

should take into consideration other aspects of health that might be overlooked during this 243

pandemic. 244



https://doi.org/10.1101/2020.07.11.20150193


14

References

1. Sohrabi C, Alsafi Z, O’Neill N, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg Lond Engl. 2020;76:71-76. doi:10.1016/j.ijsu.2020.02.034

2. Balhara YPS, Kattula D, Singh S, Chukkali S, Bhargava R. Impact of lockdown following COVID-19 on the gaming behavior of college students. Indian J Public Health. 2020;64(Supplement):S172-S176. doi:10.4103/ijph.IJPH_465_20

3. Ayittey FK, Ayittey MK, Chiwero NB, Kamasah JS, Dzuvor C. Economic impacts of Wuhan 2019-nCoV on China and the world. J Med Virol. 2020;92(5):473-475. doi:10.1002/jmv.25706

4. Wilder-Smith A, Freedman DO. Isolation, quarantine, social distancing and community containment: pivotal role for old-style public health measures in the novel coronavirus (2019-nCoV) outbreak. J Travel Med. 2020;27(2). doi:10.1093/jtm/taaa020

5. Matrajt L, Leung T. Evaluating the Effectiveness of Social Distancing Interventions to Delay or Flatten the Epidemic Curve of Coronavirus Disease. Emerg Infect Dis. 2020;26(8). doi:10.3201/eid2608.201093

6. Dyer O. Covid-19 hot spots appear across Latin America. BMJ. 2020;369. doi:10.1136/bmj.m2182

7. Decreto Supremo N° 044-2020-PCM. March 2020. https://www.gob.pe/institucion/pcm/normas-legales/460472-044-2020-pcm. Accessed July 2, 2020.

8. Decreto Supremo N° 116-2020-PCM. June 2020. https://www.gob.pe/institucion/pcm/normas-legales/738529-116-2020-pcm. Accessed July 2, 2020.

9. Alvarez-Risco A, Mejia CR, Delgado-Zegarra J, et al. The Peru Approach against the COVID-19 Infodemic: Insights and Strategies. Am J Trop Med Hyg. June 2020. doi:10.4269/ajtmh.20-0536

10. Gerli AG, Centanni S, Miozzo MR, et al. COVID-19 mortality rates in the European Union, Switzerland, and the UK: effect of timeliness, lockdown rigidity, and population density. Minerva Med. June 2020. doi:10.23736/S0026-4806.20.06702-6

11. Alfano V, Ercolano S. The Efficacy of Lockdown Against COVID-19: A Cross-Country Panel Analysis. Appl Health Econ Health Policy. June 2020. doi:10.1007/s40258-020-00596-3

12. Lau H, Khosrawipour V, Kocbach P, et al. The positive impact of lockdown in Wuhan on containing the COVID-19 outbreak in China. J Travel Med. 2020;27(3). doi:10.1093/jtm/taaa037

13. Thakur K, Kumar N, Sharma N. Effect of the Pandemic and Lockdown on Mental Health of Children. Indian J Pediatr. May 2020:1. doi:10.1007/s12098-020-03308-w

14. Killgore WDS, Taylor EC, Cloonan SA, Dailey NS. Psychological resilience during the COVID-19 lockdown. Psychiatry Res. 2020;291:113216. doi:10.1016/j.psychres.2020.113216



https://doi.org/10.1101/2020.07.11.20150193


15

15. Zheng L, Miao M, Lim J, Li M, Nie S, Zhang X. Is Lockdown Bad for Social Anxiety in COVID-19 Regions?: A National Study in The SOR Perspective. Int J Environ Res Public Health. 2020;17(12). doi:10.3390/ijerph17124561

16. Thakur V, Jain A. COVID 2019-suicides: A global psychological pandemic. Brain Behav Immun. April 2020. doi:10.1016/j.bbi.2020.04.062

17. Marques ES, Moraes CL de, Hasselmann MH, Deslandes SF, Reichenheim ME. Violence against women, children, and adolescents during the COVID-19 pandemic: overview, contributing factors, and mitigating measures. Cad Saude Publica. 2020;36(4):e00074420. doi:10.1590/0102-311X00074420

18. Mohler G, Bertozzi AL, Carter J, et al. Impact of social distancing during COVID-19 pandemic on crime in Los Angeles and Indianapolis. J Crim Justice. 2020;68:101692. doi:10.1016/j.jcrimjus.2020.101692

19. Ashby MPJ. Initial evidence on the relationship between the coronavirus pandemic and crime in the United States. Crime Sci. 2020;9(1). doi:10.1186/s40163-020-00117-6

20. Stickle B, Felson M. Crime Rates in a Pandemic: the Largest Criminological Experiment in History. Am J Crim Justice. June 2020. doi:10.1007/s12103-020-09546-0

21. Shayegh S, Malpede M. Staying Home Saves Lives, Really! Rochester, NY: Social Science Research Network; 2020. doi:10.2139/ssrn.3567394

22. Vieira PR, Garcia LP, Maciel ELN. [The increase in domestic violence during the social isolation: what does it reveals?]. Rev Bras Epidemiol Braz J Epidemiol. 2020;23:e200033. doi:10.1590/1980-549720200033

23. Sacco MA, Caputo F, Ricci P, et al. The impact of the Covid-19 pandemic on domestic violence: The dark side of home isolation during quarantine. Med Leg J. June 2020:25817220930553. doi:10.1177/0025817220930553

24. Women U. COVID-19 and Ending Violence against Women and Girls. New York. https://www. unwomen. org/-/media/headquarters/attachments …; 2020.

25. Boserup B, McKenney M, Elkbuli A. Alarming trends in US domestic violence during the COVID-19 pandemic. Am J Emerg Med. April 2020. doi:10.1016/j.ajem.2020.04.077

26. Kerimray A, Baimatova N, Ibragimova OP, et al. Assessing air quality changes in large cities during COVID-19 lockdowns: The impacts of traffic-free urban conditions in Almaty, Kazakhstan. Sci Total Environ. 2020;730:139179. doi:10.1016/j.scitotenv.2020.139179

27. Morris D, Rogers M, Kissmer N, Du Preez A, Dufourq N. Impact of lockdown measures implemented during the Covid-19 pandemic on the burden of trauma presentations to a regional emergency department in Kwa-Zulu Natal, South Africa. Afr J Emerg Med. June 2020. doi:10.1016/j.afjem.2020.06.005

28. Nuñez JH, Sallent A, Lakhani K, et al. Impact of the COVID-19 Pandemic on an Emergency Traumatology Service: Experience at a Tertiary Trauma Centre in Spain. Injury. 2020;51(7):1414-1418. doi:10.1016/j.injury.2020.05.016



https://doi.org/10.1101/2020.07.11.20150193


16

29. Cheung YT, Chau PH, Yip PSF. A revisit on older adults suicides and Severe Acute Respiratory Syndrome (SARS) epidemic in Hong Kong. Int J Geriatr Psychiatry. 2008;23(12):1231-1238. doi:10.1002/gps.2056

30. Wasserman IM. The Impact of Epidemic, War, Prohibition and Media on Suicide: United States, 1910–1920. Suicide Life Threat Behav. 1992;22(2):240-254. doi:10.1111/j.1943-278X.1992.tb00231.x

31. Información de Fallecidos del Sistema Informático Nacional de Defunciones - SINADEF - [Ministerio de Salud] | Plataforma Nacional de Datos Abiertos. https://www.datosabiertos.gob.pe/dataset/informaci%C3%B3n-de-fallecidos-del-sistema-inform%C3%A1tico-nacional-de-defunciones-sinadef-ministerio. Accessed July 2, 2020.

32. Vargas-Herrera J, Pardo Ruiz K, Garro Nuñez G, et al. Resultados preliminares del fortalecimiento del sistema informático nacional de defunciones. Rev Peru Med Exp Salud Publica. 2018;35(3):505-514. doi:10.17843/rpmesp.2018.353.3913

33. PERÚ - INEI:: Perú: Resultados Definitivos de los Censos Nacionales 2017. https://www.inei.gob.pe/media/MenuRecursivo/publicaciones_digitales/Est/Lib1544/. Accessed July 2, 2020.

34. Zylke JW, Bauchner H. Mortality and Morbidity: The Measure of a Pandemic. JAMA. July 2020. doi:10.1001/jama.2020.11761

35. Leon DA, Shkolnikov VM, Smeeth L, Magnus P, Pechholdová M, Jarvis CI. COVID-19: a need for real-time monitoring of weekly excess deaths. Lancet Lond Engl. 2020;395(10234):e81. doi:10.1016/S0140-6736(20)30933-8

36. Google LLC. Google COVID-19 Community Mobility Reports. https://www.google.com/covid19/mobility/data_documentation.html. Accessed July 2, 2020.

37. Turner SL, Karahalios A, Forbes AB, et al. Design characteristics and statistical methods used in interrupted time series studies evaluating public health interventions: a review. J Clin Epidemiol. 2020;122:1-11. doi:10.1016/j.jclinepi.2020.02.006

38. Hawley S, Ali MS, Berencsi K, Judge A, Prieto-Alhambra D. Sample size and power considerations for ordinary least squares interrupted time series analysis: a simulation study. Clin Epidemiol. 2019;11:197.

39. Peru. .: REUNIS�:. Repositorio Único Nacional de Información en Salud - Ministerio de Salud. http://www.minsa.gob.pe/reunis/index.asp?op=51&box=712&item=712. Published 2019. Accessed July 9, 2020.

40. Gunnell D, Appleby L, Arensman E, et al. Suicide risk and prevention during the COVID-19 pandemic. Lancet Psychiatry. 2020;7(6):468-471. doi:10.1016/S2215-0366(20)30171-1

41. Sher L. COVID-19, anxiety, sleep disturbances and suicide. Sleep Med. 2020;70:124. doi:10.1016/j.sleep.2020.04.019

42. Campedelli GM, Aziani A, Favarin S. Exploring the Effect of 2019-nCoV Containment Policies on Crime: The Case of Los Angeles. ArXiv200311021 Econ Q-Fin Stat. March 2020. doi:10.31219/osf.io/gcpq8



https://doi.org/10.1101/2020.07.11.20150193


17

43. Ribeiro E, Borges D, Cano I. Calidad de los datos de homicidio en América Latina. Bras Lab Análisis Violencia–Universidad Estado Rio Jan. 2015.

44. Drugs UNO on, Crime. Global Study on Homicide 2019: Executive Summary. United Nations Office on Drugs and Crime; 2019.

45. Crimen cae en calles de Latinoamérica en tiempos de COVID-19. AP NEWS. https://apnews.com/79e12fe6ab9d4db8bbba247048f9f7fc. Published April 10, 2020. Accessed July 3, 2020.

46. Crime G. Crime and Contagion: The Impact of a Pandemic on Organized Crime. Global Initiative Against Transnational Organized Crime. Geneva, Switzerland. Retrieved April 25, 2020.; 2020.

47. Asher J, Horwitz B. It’s Been ‘Such a Weird Year.’ That’s Also Reflected in Crime Statistics. The New York Times. https://www.nytimes.com/2020/07/06/upshot/murders-rising-crime-coronavirus.html. Published July 6, 2020. Accessed July 9, 2020.

48. Angelica Motta. La Biologia Del Odio: Retoricas Fundamentalistas y Otras Violencias de Genero. 1st ed. Lima Perú: La Siniestra Ensayos; 2019.

49. Neil J. Domestic violence and COVID-19: Our hidden epidemic. Aust J Gen Pract. 2020;49. doi:10.31128/AJGP-COVID-25

50. Casana-Jara KM. Características de la muerte de mujeres por violencia según las necropsias realizadas en la morgue del Callao. Rev Peru Med Exp Salud Pública. 2020;37(2):297-301. doi:10.17843/rpmesp.2020.372.5111

51. Torales J, O’Higgins M, Castaldelli-Maia JM, Ventriglio A. The outbreak of COVID-19 coronavirus and its impact on global mental health. Int J Soc Psychiatry. 2020;66(4):317-320. doi:10.1177/0020764020915212

52. Monjur MR. COVID-19 and suicides: The urban poor in Bangladesh. Aust N Z J Psychiatry. June 2020:0004867420937769. doi:10.1177/0004867420937769

53. Shoib S, Nagendrappa S, Grigo O, Rehman S, Ransing R. Factors associated with COVID-19 outbreak-related suicides in India. Asian J Psychiatry. 2020;53:102223. doi:10.1016/j.ajp.2020.102223

54. McIntyre RS, Lee Y. Projected increases in suicide in Canada as a consequence of COVID-19. Psychiatry Res. 2020;290:113104. doi:10.1016/j.psychres.2020.113104

55. Gutiérrez Espino C, others. Perú: brechas de género 2018. Avances hacia la igualdad de hombres y mujeres. 2018.

56. Instituto Nacional de Estadistica e Informatica. Situación del mercado laboral en Lima Metropolitana. http://m.inei.gob.pe/biblioteca-virtual/boletines/informe-de-empleo/1/#lista. Published 2020. Accessed July 10, 2020.

57. Sakelliadis EI, Katsos KD, Zouzia EI, Spiliopoulou CA, Tsiodras S. Impact of Covid-19 lockdown on characteristics of autopsy cases in Greece. Comparison between 2019 and 2020. Forensic Sci Int. 2020;313:110365. doi:10.1016/j.forsciint.2020.110365



https://doi.org/10.1101/2020.07.11.20150193


18

58. Mamun MA, Griffiths MD. First COVID-19 suicide case in Bangladesh due to fear of COVID-19 and xenophobia: Possible suicide prevention strategies. Asian J Psychiatry. 2020;51:102073. doi:10.1016/j.ajp.2020.102073

59. VanderWeele TJ. Challenges Estimating Total Lives Lost in COVID-19 Decisions: Consideration of Mortality Related to Unemployment, Social Isolation, and Depression. JAMA. July 2020. doi:10.1001/jama.2020.12187



https://doi.org/10.1101/2020.07.11.20150193


19

Tables

Table 1. Interrupted time series coefficients by sex and type of violent or accidental death

Type of death x

1,000,000

1 year

Slope (95% CI)

Post-lockdown

Difference per month (95% CI)

Post-lockdown x

1 year Interaction (95% CI)

Women

Homicide 0.10 (0.04, 0.16) -1.05 (-1.74, -0.37) 0.07 (-2.09, 2.23)

Suicide 0.13 (0.08, 0.18) -1.08 (-1.68, -0.48) 0.28 (-1.61, 2.18)

Traffic accident 0.14 (0.01, 0.28) -3.64 (-5.25, -2.03) 0.35 (-4.72, 5.43)

Other accident 0.22 (0.12, 0.32) -2.21 (-3.42, -1.01) -0.96 (-4.76, 2.84)

Men

Homicide 0.68 (0.53, 0.83) -5.50 (-7.28, -3.72) 0.99 (-4.64, 6.61)

Suicide 0.24 (0.15, 0.33) -2.62 (-3.75, -1.49) 3.62 (0.06, 7.18)

Traffic accident 0.75 (0.51, 0.99) -12.66 (-15.56, -9.76) 7.31 (-1.83, 16.46)

Other accident 0.45 (0.26, 0.63) -5.68 (-7.89, -3.48) -0.36 (-7.32, 6.60)



https://doi.org/10.1101/2020.07.11.20150193


20

Figures

Figure 1. Interrupted time-series analysis violent deaths by type of death in Women. The vertical black dashed line corresponds to the beginning of the lockdown (March 16, 2020) and the grey shading to the lockdown period. The solid red lines correspond to the interrupted time-series linear regression model, the solid blue line corresponds to the LOESS smoother and the blue shading corresponds to a 0.6 smoothing span around the LOESS smoother line.



https://doi.org/10.1101/2020.07.11.20150193


21

Figure 2. Interrupted time-series analysis violent deaths by type of death in Men. The vertical black dashed line corresponds to the beginning of the lockdown (March 16, 2020) and the grey shading to the lockdown period. The solid red lines correspond to the interrupted time-series linear regression model, the solid blue line corresponds to the LOESS smoother and the blue shading corresponds to a 0.6 smoothing span around the LOESS smoother line.



https://doi.org/10.1101/2020.07.11.20150193


22

Figure 3. Panel A: Interrupted time-series analysis the propotion of violent deaths labeled as “unescpecified”. The solid red lines correspond to the interrupted time-series regression model. Panel B: Descriptive view of the percentage change in community mobility to transit stations before and after the lockdown period. The first vertical black dotted line corresponds to the firs case confirmation and the second the 40 day lockdown mark. Panel A and B: The vertical black dashed line corresponds to the beginning of the lockdown (March 16, 2020) and the the grey shading to the lockdown period, the solid blue line corresponds to the LOESS smoother and the blue shading corresponds to a 0.6 smoothing span around the LOESS smoother line.



https://doi.org/10.1101/2020.07.11.20150193


Documents

Impact of COVID-19 Lockdown Policy on Homicide, Suicide ......2020/07/11 · The mental health effects of COVID-19 and of the accompanying economic crisis have also been profound,